Differentiation, invasion risk factors in metastatic cutaneous squamous cell carcinoma
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Poor differentiation and deep invasion are the most common risk factors for metastatic cutaneous squamous cell carcinoma following diameter and thickness, according to a study.
“Cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers worldwide with metastatic potential,” Selin Tokez, MSc, of the Erasmus MC Cancer Institute at the University Medical Center Rotterdam in the Netherlands, and colleagues wrote. “The high incidence of primary cSCC makes it challenging to correctly identify the small percentage (2% to 5%) of patients who are at high risk for metastasis and would benefit from intense surveillance and/or adjuvant treatment strategies.”
Two nested case-control studies from England and the Netherlands used nationwide cancer registry cohorts to identify metastatic cases and match them to controls.
The English group included 887 metastatic cases and 887 nonmetastatic cases, while the Dutch group included 217 metastatic and 217 nonmetastatic cases.
Tumor characteristics from pathology included location, macroscopic diameter, thickness, differentiation grade, morphology, perineural/lymphovascular invasion and the extent of tissue involvement.
Diameter and thickness were categorized using the American Joint Committee of Cancer 8th edition (AJCC8) and diameter was categorized using the Brigham and Women’s Hospital staging system.
While thickness and diameter have previously been found to be the most significant risk factors for metastasis, this study aimed to identify the OR of other tumor characteristics.
A backward stepwise selection found poor differentiation to have an OR of 4.56 (95% CI, 2.99-6.94). Invasion beyond subcutaneous fat had an OR of 4.43 (95% CI, 1.98-9.9) and male sex had an OR of 2.59 (95% CI 1.7-3.96).
“Following tumor diameter and thickness, poor differentiation proved an important risk factor for metastasis despite being omitted from the AJCC8, thereby emphasizing the importance of reviewing and refining current staging systems,” the authors wrote.